Lessons for Health Care Policy in the United States: Comparing Health Care Systems CHRISTIAN ASPALTER
Professor of Social Policy, Former Head Social Work and Social Administration Program Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China Note: A shorter version of this paper has been published in C. Aspalter, Y. Uchida and R. Gauld (eds.) (2011) “Health Care Systems in Europe and Asia” (Routledge Studies in Social Welfare in Asia), Routledge: London.
Health care systems are one of the most complex and comprehensive administrative and policy systems that there are. They are not to be comprehended by looking at any single data or perspective. They are constantly developing. They are elusive and often misunderstood, i.e. they may be mistaken for something they are not, or certain aspects may be overestimated or underestimated. Health care systems are needed, loved and detested. There are, as a matter of fact, a great deal of misperceptions and misunderstandings when it comes to health care. The recent debate in the United States, to name just one illustrative example, has clouded the issue of health care policy and health care reform in greater mystery than it helped to unravel and reveal new insights to the actual facts. In the comparative study below, we will see that for instance the United States would be among the top three world health care systems in terms of “socialism,” or, in other words, absolute public spending per capita for health care. Only in Luxembourg and Norway, does the government spend more on health care per person that in the United States (5,212, 4,006 and 3,315 PPP/US$ respectively). The often cited case of the United Kingdom, in the American debate, would not qualify to be only a moderate “socialist” health care system after all, as the UK government only spends 2,444 PPP/US$ per capita on health care, compared to 3,315 PPP/US$ spent by the American government. So, the health care system in the United States, as it is, is actually about 35 percent more “socialist” than that of the United Kingdom. In terms of percentage of GDP, the US leads the world in terms of total health spending, making it not the best health care system, but the most expensive health care system—both in relative terms (% of GDP) and in absolute terms (per capita expenditure, PPP/US$).
Electronic copy available at: http://ssrn.com/abstract=1960821
Measuring and Comparing Health Care Systems The best health care systems are the ones that need less money and, at the same time, cure more patients and prevent more illness and suffering. Health care outcomes are not too difficult to find and to measure, life expectancy and healthy life expectancy rates are easily available and comparable, and so are neonatal, infant, below-5, maternity and adult mortality rates. The service delivery itself can also be measured satisfactorily in comparative terms, i.e. by looking at the ratios of doctors, nurses and midwifery personnel, hospital beds, acute hospital beds, MRIs and CT scans to the population, as well as GP visits per person per year, average stay in hospital per person, etc. Effectiveness is output. Efficiency is the ratio of output to input. Input is relatively easily measured as well, through absolute health care spending per capita in PPP/US$. Though, there are problems, when doing so. For example, the costs of buildings and administration are in actual fact not supporting directly the health of patients, and there is a lot of room for redundancy and wasteful investment in these areas. Also, PPP/US$ favors Western countries, since PPP is based on e.g. hamburgers, a food item which is expensive in e.g. Asia, but comparatively very cheap in Western countries, e.g. what may be a luxury item in the East, is a food for the poor in the West, and vice versa. Hence, misrepresentations between different continents are always possible (and actually certain). In China, people do not eat...
References: Aspalter, C. (2001a), Conservative Welfare State Systems in East Asia, Praeger, Westport, CT. Aspalter, C. (2001b), On the Road to a Taiwanese Welfare State: Political Parties Capitalizing on the Issue of Social Welfare, in C. Aspalter (ed.), Understanding Modern Taiwan: Essays in Economics, Politics and Social Policy, Ashgate: Aldershot, UK. Aspalter, C. (2002a), Democratization and Welfare State Development in Taiwan, Ashgate: Aldershot, UK. Aspalter, C. (2002b), Singapore: A Welfare State in a Class by Itself, in C. Aspalter (ed.), Discovering the Welfare State in East Asia, Praeger, Westport, CT. Aspalter, C. (2006), The East Asian Welfare Model, International Journal of Social Welfare, Vol. 15, pp. 290-301. Aspalter, C. (2007a), The Asian Cure for Health Care, Far Eastern Economic Review, November, pp. 55-59. Aspalter, C. (2007b), Aging and the Chinese Welfare State: Managing the Transition from Industrial to Post-Industrial Welfare, in I. Cook and J. Powell (eds.), New Perspectives on China and Aging, Nova Science: New York.
Aspalter, C. (2010), Towards “Human Capital Solidarity”: Emphasizing Justice in the Distribution of Physical, Mental, Social and Cultural Capabilities, www.issa. int/Resources/Conference-Reports. Aspalter, C. (2011), Developing Ideal-Typical Welfare Regime Theory, International Social Work, Vol. 54/2, pp. 735-50. Aspalter, C.; Kim, J., and Park, S. (2009), The Welfare States in Poland, Czech Re-public, Hungary and Slovenia: An Ideal-Typical Perspective, Social Policy and Administration 43(2): 170-185. Beck, U. (1992), Risk Society: Towards a New Modernity, Sage: London. Beck, U. (2000), Brave New World of Work, Polity: Cambridge, UK. Borzutzky, S. (2002a), Vital Connections: Politics, Social Security, and Inequality in Chile, University of Notre Dame Press: Notre Dame, IN. Borzutzky, S. (2002b), Chile’s Fully Funded System: An Analysis of Its Impact on the State and the Society, paper presented at the international conference Issues and Prospect of the Welfare Society in the 21st Century: Experience of the West and Experiment of the East, Seoul National University, Seoul, Korea. Esping-Andersen, G. (ed.) (1996), Welfare States in Transition: National Adaptations in Global Economies, Sage: London. Esping-Andersen, G. (1999), Social Foundations of Postindustrial Economies, Oxford University Press: Oxford, UK. Esping-Andersen, G. (2002), Why We Need a New Welfare State, Oxford University Press: Oxford, UK. Esping-Andersen, G. (2009), Incomplete Revolution: Adapting Welfare States to Wo-men’s New Roles, Polity: Bristol, UK. Fu, T.H. and Hughes, R. (eds.) (2009), Ageing in East Asia: Challenges and Policies for the Twenty-First Century, Routledge: London. Gauld, R. (ed.) (2005), Comparative Health Policy in the Asia-Pacific, Open Uni-versity Press: Maidenhead, UK. Goodman, R.; White, G.; and Kwon, H.J. (1998), The East Asian Welfare State Model, Routledge: London. Gough, I. (2002), Globalization and National Welfare Regimes: The East Asian Case, in R. Sigg and C. Behrendt (eds.), Social Security in the Global Village, Trans-action: London, pp. 47-65. Haggard, S. and Kaufmann, R. (2004), Revising Social Contracts: Social Spending in Latin America, East Asia, and the Former Socialist Countries, paper presented at International Symposium on Comparative Social Policy, National Chi Nan Uni-versity, Puli, Taiwan, May 31. Haggard, S. and Kaufmann, R. (2008), Development, Democracy, and Welfare States: Latin America, East Asia, and Eastern Europe, Princeton University Press: Hsieh, C.R. and Hu, T.W (eds.) (2002), The Economics of Health Care in Asia-Pacific Countries, Edward Elgar: London. Ku, Y.W. (1995), The Development of State Welfare in the East Asian NICs with Special Reference to Taiwan, Social Policy and Administration, Vol. 29, No. 4, pp. 345-64. Kwon, H.J. (ed). (2005) Transforming the Developmental Welfare State, Palgrave Macmillan: London. Mesa-Lago, C. (2003), The Welfare State in Eight Latin American Countries, in C. Aspalter (ed.), Welfare Capitalism Around the World, Casa Verde Publishing: Hong Kong. Mesa-Lago, C. (2008), Reassembling Social Security: A Survey of Pensions and Health Care Reforms in Latin America, Oxford University Press: Oxford, UK. Meulen, R. et al. (eds.) (2011), Solidarity in Health and Social Care in Europe, Sprin-ger: Berlin. Midgley, J. (1986), Industrialisation and Welfare: The Case of the Four Little Tigers, Social Policy and Administration, Vol. 20, No. 7, pp. 225-38. Midgley, J. (2008), Developmental Social Policy: Theory and Practice, in S. Singh and C. Aspalter (eds.), Debating Social Development, Casa Verde: Hong Kong. Ramesh, M. (2003), Globalization and Social Security Expansion in East Asia, in L. Weiss (ed.), States in the Global Economy: Bringing Domestic Institutions Back In, Cambridge University Press: Cambridge, UK.
Ramesh, M. (2004), Social Policy in East and Southeast Asia: Education, Health, Housing, and Income Maintenance, Routledge: London. Ringen, S. et al. (2011), The Korean State and Social Policy: How South Korea Lifted Itself from Poverty and Dictatorship to Affluence and Democracy, Oxford Uni-versity Press: Oxford, UK. Taylor-Gooby, P. (ed.) (2005) New Risks, New Welfare, Oxford University Press; Ox-ford, UK. UNDP (2011), HDI Disaggregation: Problems and Possible Approaches, europeand cis.undp.org/uploads/public/file/HDI_disaggregation.doc. WHO, World Health Organization (2010), World Health Statistics 2010, World Health Organization: Geneva, Switzerland. WP, Wikipedia (2011), Health Insurance Coverage in the United States, en.wikipedia. org/wiki/health_insurance_coverage_in_the_United_States.
Please join StudyMode to read the full document